Physical activity and healthcare utilization in France: evidence from the European Health Interview Survey (EHIS) 2014

Background A growing need and focus on preventing and controlling the diseases and promoting a healthier lifestyle is more evident at global, regional, and national levels. In this respect, it is well-known the positive association between physical activity and population’s health, but also its negative association with the demand of healthcare, which could lead to lower spending on healthcare systems. In France, a lack of physical activity, a high prevalence of sedentary behaviours, and a continuous deterioration of these behaviours are observed since 2006. Therefore, promoting and increasing physical activities could contribute to major societal issues. Within this context, the study aims to analyse how the use of different healthcare services are related to physical activity in a nationally representative sample of French population. Methods The data used was retrieved from the second wave of the EHIS-ESPS 2014. The relationship between physical activity and healthcare utilization, controlled by a set of socioeconomic, demographic, and health behaviour factors, was explored both at the level of the entire population and separately for two age groups (less than 65 years, 65 years and older), employing probit and recursive multivariate probit models. Results Our findings underline that the relation between healthcare utilization and physical activity depends on the type of healthcare services and age group. In this respect, only among adult respondents, we observe a significant negative association between physical activity and prescribed medicines consumption and day hospitalization, while preventive services use is positively related to physical activity. Common to both age groups, the positive association of physical activity with general physician services and non-prescribed medicines reveal that moderately and highly active adults and elders may be more health conscious and therefore may seek referrals to generalist and other prevention measures more frequently than their inactive counterparts. This explanation is also sustained by the negative association between physical activity and overnight hospitalization or home healthcare services. Conclusions This study highlights the double role of physical activity on health as preventive measure and treatment and thus support the implementation of public health policies aimed at increasing the level of physical activity in French population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13479-0.

kg/m 2 ); obese (≥ 30 kg/m 2 ) smoking status non-smoker; occasional smoker; light or heavy daily smoker drinking profile no-risk (non-consumer, safe consumer); risky (one-time risk consumer, chronic and dependent consumer) nutrition (frequency of eating fruits and vegetables and its quantity on a daily basis) insufficient (do not respect the recommendations of eating at least 5 fruits and vegetables on a daily basis); sufficient (otherwise)   < 3 ds/wk and < 1 h/d of walking or < 3 ds/wk and < 10 min/d of riding a bike or making sports or < 3 ds/wk of muscle building exercises < 5 ds/wk and < 1 h/d of walking or < 5 ds/wk and < 30 min/d of riding a bike or making sports or 0 ds/wk of muscle building exercises < 5 ds/wk and < 30 min/d of walking or < 5 ds/wk and < 10 min/d of riding a bike or making sports or < 2 ds/wk of muscle building exercises moderate physically active ≥ 3 ds/wk and 1-2 h/d of walking or ≥ 3 ds/wk and 10 min-2 h/d of riding a bike or making sports or ≥ 3 ds/wk of muscle building exercises ≥ 5 ds/wk and 1-2 h/d of walking or ≥ 5 ds/wk and 30 min-2 h/d of riding a bike or making sports or ≥ 1 ds/wk of muscle building exercises ≥ 5 ds/wk and 30 min-2 h/d of walking or ≥ 5 ds/wk and 10 min-2 h/d of riding a bike or making sports or ≥ 2 ds/wk of muscle building exercises high physically active ≥ 3 ds/wk and ≥ 2 h/d of walking, or ≥ 3 ds/wk and ≥ 2 h/d of riding a bike or making sports or ≥ 3 ds/wk of muscle building exercises ≥ 5 ds/wk and ≥ 2 h/d of walking, or ≥ 5 ds/wk and ≥ 2 h/d of riding a bike or making sports or ≥ 1 ds/wk of muscle building exercises ≥ 5 ds/wk and ≥ 2 h/d of walking, or ≥ 2 ds/wk and ≥ 2 h/d of riding a bike or making sports or ≥ 2 ds/wk of muscle building exercises Notes: wk stands for weeks; ds stands for days; h stands for hours; min stands for minutes Notes:

Modelling results
(1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index). (3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable.
(2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).  (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association).  (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index). Notes: (1) The coefficients indicate the difference between the probit index (Z-score) of each category of each independent variable and that corresponding to the reference category of each independent variable. (2) The reference categories for the independent variables are: low active (physical activity); 15-24 years (age group for those younger than 65 years old); 65-69 years (age group for those of 65 years and older); male (sex of respondent); primary education level (education); unmarried (legal marital status); unemployed (employment status); private health insurance (insurance); more than 1500 euros (income level); overweight (BMI status); never (smoking); no-risk (alcohol consumption risk profile); recommended (nutritionfruits and vegetables consumption); poor health (health index).
(3) The reference categories for each instrumental variable are: without school (parents' education); preoccupied (attitude towards future); yes (membership in an association).